LCBDE+LC与ERCP/EST+LC治疗胆囊结石合并胆总管结石的疗效对比

Comparison of the Efficacy of LCBDE +LC and ERCP/EST +LC in the Treatment of Cholecystolithiasis and Choledocholithiasis

目的比较腹腔镜胆总管探查术(LCBDE)+腹腔镜胆囊切除术(LC)与内镜下逆行胰胆管造影(ERCP)及乳头括约肌切开取石术(EST)+LC治疗胆囊结石合并胆总管结石的临床疗效。方法研究对象选自该院2015年10月—2017年6月收治的172例胆囊结石合并胆总管结石患者,根据手术方式的不同分成两组,其中A组89例给予LCBDE+LC治疗,B组73例给予ERCP/EST+LC治疗,比较两组手术疗效。结果 A组结石清除率、中转开腹率、并发症发生率、结石复发率分别为95.51%、5.62%、7.87%、3.37%,B组分别为91.78%、5.48%、8.22%、5.48%,两组比较差异无统计学意义(P>0.05)。A组手术时间为(125.24±22.34)min,B组为(98.67±16.46)min,A组手术时间明显长于B组;A组住院时间为(7.12±1.85)d,B组为(12.47±2.45)d,A组住院时间明显短于B组;A组手术费用及住院费用分别为(5 804.23±642.56)元、(2.24±0.48)万元,B组分别为(8 208.46±834.67)元、(2.95±0.57)万元,A组手术费用及住院费用明显低于B组(P<0.05)。结论 LCBDE+LC与ERCP/EST+LC治疗胆囊结石合并胆总管结石均能取得显著的治疗效果,ERCP/EST+LC手术时间更短,LCBDE+LC具有更高的成本效益,二者均有各自的适应症,具体选择何种手术方式应视患者情况而定。

Objective This paper tries to compare the clinical efficacy of laparoscopic common bile duct exploration(LCBDE)+laparoscopic cholecystectomy(LC)and endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic sphincterotomy(EST)+LC in the treatment of cholecystolithiasis and choledocholithiasis.Methods 172 cases of cholecystolithiasis and choledocholithiasis patients were selected from this hospital from October 2015 to June 2017,according to different surgical methods,they were divided into two groups,including 89 cases in group A treated with LCBDE+LC,group B of 73 cases treated with ERCP/EST+LC and the curative effect was compared between the two groups.Results The stone clearance rate,conversion rate,complication rate and stone recurrence rate in group A were 95.51%,5.62%,7.87%and 3.37%respectively,and those in group B were 91.78%,5.48%,8.22%and 5.48%respectively.There was no significant difference between the two groups(P>0.05).The operation time of group A was(125.24±22.34)min,group B was(98.67±16.46)min,the operation time of group A was significantly longer than that in group B;group A for the length of time(7.12±1.85)d,group B(12.47±2.45)d,hospitalization time of group A was significantly shorter in group B;operation expenses and hospitalization expenses in group A were(5 804.23±642.56)yuan,(22.4±4.8)thousand yuan,group B respectively(8 208.46±834.67)yuan,(29.5±5.7)thousand yuan,operation expenses and hospitalization costs in group A were lower than those of group B(P<0.05).Conclusion LCBDE+LC and ERCP/EST+LC for the treatment of cholecystolithiasis and choledocholithiasis can achieve significant therapeutic effect,ERCP/EST+LC has a shorter operation time,LCBDE+LC is more cost-effective,both have their own specific indications,the choice of surgical approach should be considered in patients with conditions.